How did the Women's Health Initiative (WHI) change menopause care, and what is now understood about its findings?

The Women's Health Initiative (WHI), launched in the 1990s, dramatically changed menopause care when its results were released in 2002. The study was stopped early after findings suggested that hormone therapy (specifically estrogen plus progestin) increased the risk of breast cancer, heart disease, and stroke in postmenopausal women. This led to a sharp decline—up to 80%—in the use of menopausal hormone therapy (MHT) and a lot of fear and confusion among women and healthcare providers.

However, the WHI findings were later found to be misinterpreted and sensationalized. Key issues included:

• The average age of women in the study was 63, with many participants well past the typical age for starting MHT. Most were not newly menopausal, and many had additional health risks (like diabetes, smoking, and obesity).
• The study used higher doses and different formulations of hormones than what is commonly prescribed today.
• The increased breast cancer risk was very slight and only seen in women taking both estrogen and progestin. Women who took estrogen alone (usually those who had a hysterectomy) actually had a decreased risk of breast cancer.

Now, every major medical society—including The Menopause Society, the American College of Obstetricians and Gynecologists, and the Endocrine Society—agrees that for most healthy, symptomatic women, MHT is the safest and most effective treatment for menopause symptoms. The benefits, such as relief from hot flashes, prevention of bone loss, and improved quality of life, far outweigh the risks for most women. There is also no longer a strict age or time limit for MHT use; decisions are individualized based on each woman's needs and preferences.

For a deeper dive, check out:

• The Menopause Society's 2022 Position Statement
• New England Journal of Medicine article on the WHI's impact
• Estrogen Matters by Avrum Bluming

If you want to hear experts discuss the WHI and its impact, watch these YouTube chapters:

• Impact of the Women's Health Initiative on Menopause Care (Dr. Jayne Morgan)
• The Women's Health Initiative Study (Dr. Sharon Malone & Maria Shriver)

Here at Alloy, we base our menopause care on the latest science and guidelines. If you're interested in learning more about our MHT options, visit our menopause solutions page or get started with our online assessment.

---

This answer was created using the following resources:

• Menopause, Hormones & Your Heart: What You Need to Know | Dr. Jayne Morgan - Impact of the Women's Health Initiative on Menopause Care
• Menopause Myth Busting: Separating Fact from Fiction | Dr. Mary Jane Minkin - Media Coverage and the Women's Health Initiative
• Big News for Menopause!
• Understanding Hormones During Menopause | Dr. Mary Jane Minkin - The Women’s Health Initiative and Estrogen Safety
• Debunking the Myth: Estrogen Therapy and Breast Cancer Risk | Dr. Mary Jane Minkin
• Sex Cells: The Fight to Overcome Bias and Discrimination in Women’s Healthcare | Phyllis Greenberger - Menopause and Hormone Therapy Controversy
• Alloy's Dr. Sharon Malone and Today's Maria Shriver Talk about MHT - The Women's Health Initiative Study
• Menopause Hormone Guide: Expert Insights
• NAMS Issues Updated Guidelines on Hormones